THE ABILITY OF THE CHEMILUMINESCENCE TEST TO PREDICT CLINICAL OUTCOMEAND THE NECESSITY FOR AMNIOCENTESES IN PREGNANCIES AT RISK OF HEMOLYTIC-DISEASE OF THE NEWBORN

The chemiluminescence test measures the ability of anti-D to sensitise red cells for recognition by monocytes. It predicts clinical outcome in haemolytic disease of the newborn with greater precision than quant ification of anti-D levels by AutoAnalyzer. However, whether or not th e chemiluminescence test can, or should, affect clinical management is not clear. Of 56 alloimmunised women referred to a single fetal medic ine unit, 30 underwent a total 63 amniocenteses to establish the exten t of fetal haemolysis. Overall, chemiluminescence test results were a better predictor of amniocenteses with elevated bilirubin levels than the AutoAnalyzer (P < 0.01). Chemiluminescence results > 30% were alwa ys associated with elevated bilirubin levels. The chemiluminescence te st might be used to prompt the direct evaluation of fetal haemolysis i n patients with borderline levels of anti-D (5-15 IU/mL). However, the ability of the test to predict amniocenteses with normal bilirubin le vels was less clear.